Supervising Nurse Name Or License Number Required. Please Bill Medicare First. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. What your insurance agreed to pay. 100 Days Supply Opportunity. AODA Day Treatment Is Not A Covered Service For Members Who Are Residents Of Nursing Homes or Who Are Hospital Inpatients. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing. A Google Certified Publishing Partner. Please Furnish An ICD-9 Surgical Code And Corresponding Description. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Pricing Adjustment/ Spenddown deductible applied. Denied/Cutback. Billed amount exceeds prior authorized amount. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Service(s) paid at the maximum daily amount per provider per member. Amount Paid By Other Insurance Exceeds Amount Allowed By . Compound Drug Service Denied. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. Please Correct And Resubmit. Continuous home care must be billed in an hourly quantity equal to or greater than eight hours, up to and including 24 hours. The fair market value of property; technically, replacement cost less depreciation.. Actuary. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. The Second Occurrence Code Date is invalid. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. The topic of Requirements for Compression Garments can be found in the Claims Section, Submission Chapter. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. Well-baby visits are limited to 12 visits in the first year of life. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Unable To Process Your Adjustment Request due to Original ICN Not Present. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. General Assistance Payments Should Not Be Indicated On Claims. Denied. The Service Performed Was Not The Same As That Authorized By . Please File With Champus Carrier. Denied. Invalid Provider Type To Claim Type/Electronic Transaction. Procedure Code is allowed once per member per lifetime. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration. The Diagnosis Code is not payable for the member. TPA Certification Required For Reimbursement For This Procedure. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. Denied/cutback. Adjustment Requested Member ID Change. Pricing Adjustment/ Usual & Customary Charge (UCC) rate pricing applied. Look at the "provider of services" and "place of service," listed on the first EOB in this post as "Mills Hospital" and "outpatient.". Hearing Aid Batteries Are Limited To 12 Monaural/24 Binaural Batteries Per 30-day Period, Per Provider, Per Hearing Aid. DX Of Aphakia Is Required For Payment Of This Service. Denied/Cutback. when they performed them. Please Correct and Resubmit. A statistician who computes insurance risks and premiums. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Second Surgical Opinion Guidelines Not Met. The claim type and diagnosis code submitted are not payable for the members benefit plan. Use The New Prior Authorization Number When Submitting Billing Claim. Approved. Pricing Adjustment/ Prescription reduction applied. NFs Eligibility For Reimbursement Has Expired. Procedure Code Changed To Permit Appropriate Claims Processing. Participant Is Enrolled In Medicare Part D. Beginning 09/01/06, Providers AreRequired To Bill Part D And Other Payers Prior To Seniorcare Or Seniorcare WillDeny The Claim. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim. Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Denied. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. Annual Physical Exam Limited To Once Per Year By The Same Provider. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Claims With Dollar Amounts Greater Than 9 Digits. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Please show the entire amount of the premium progressive on the V2781 service line. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. PIP is a coverage in which the auto insurance company pays, within the specified limits, the medical, hospital and funeral expenses of the insured person, people in the insured vehicle and pedestrians struck by the insured vehicle. Denied. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. 12. Denied/Cutback. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. Rqst For An Acute Episode Is Denied. The Primary Diagnosis Code is inappropriate for the Procedure Code. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. These Services Paid In Same Group on a Previous Claim. Correct And Resubmit. Referring Provider is not currently certified. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. Member In TB Benefit Plan. your coverage was still in effect . This is Not a Bill . This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. Duplicate/second Procedure Deemed Medically Necessary And Payable. One or more Diagnosis Code(s) is invalid in positions 10 through 25. This drug is not covered for Core Plan members. Prior Authorization (PA) is required for this service. Claim Submitted To Good Faith Without Proper Documentation. Denied. Denied. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. The Procedure Code has Encounter Indicator restrictions. They might also make a digital copy available . 129 Single HIPPS . This Check Automatically Increases Your 1099 Earnings. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. Attachment was not received within 35 days of a claim receipt. A number is required in the Covered Days field. Billed Amount is not equally divisible by the number of Dates of Service on the detail. The website provides additional information about auto insurance in New York State. Please Resubmit As A Regular Claim If Payment Desired. Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. The Procedure Requested Is Not Allowable For The Process Type Indicated On TheRequest. Resubmit charges for covered service(s) denied by Medicare on a claim. The Revenue code on the claim requires Condition code 70 to be present for this Type of Bill. Correct And Resubmit. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). Revenue codes 0822, 0823, 0825, 0832, 0833, 0835, 0842, 0843, 0845, 0852, 0853, or 0855 exist on the ESRD claim that does not contain condition code 74. Pricing Adjustment/ Repackaging dispensing fee applied. Modifiers submitted are invalid for the Date Of Service(DOS) or are missing.. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code. Incidental modifier is required for secondary Procedure Code. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Oral exams or prophylaxis is limited to once per year unless prior authorized. This Member Has Received Primary AODA Treatment In The Last Year And Is Therefore Not Eligible For Primary Intensive AODA Treatment At This Time. Claim Is Pended For 60 Days. Detail Quantity Billed must be greater than zero. Amount allowed - See No. Service paid in accordance with program requirements. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. Service(s) Approved By DHS Transportation Consultant. Procedure Code is not payable for SeniorCare participants. This Adjustment Was Initiated By . Denied due to NDC Is Not Allowable Or NDC Is Not On File. Refer To The Wisconsin Website @ dhs.state.wi.us. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Member is assigned to a Lock-in primary provider. Did You check More Than One Box?If So, Correct And Resubmit. Services In Excess Of This Cap Are Not Reimbursable for this Member. This claim is being denied because it is an exact duplicate of claim submitted. Quantity submitted matches original claim. Therapy visits in excess of one per day per discipline per member are not reimbursable. EOB Code Description Rejection Code Group Code Reason Code Remark Code 074 Denied. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. Denied. Denied due to Procedure/Revenue Code Is Not Allowable. Here is what you'll typically find on your EOB: 1. The Second Modifier For The Procedure Code Requested Is Invalid. Denied by Claimcheck based on program policies. 7 - REMARK CODE is a note from the insurance plan that explains more about the costs, charges, and paid amounts for your visit. DME rental beyond the initial 30 day period is not payable without prior authorization. Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Personal injury protection (PIP) coverage. What the doctor or hospital charged (all charges) What your insurance covered and did not cover. Here's an example of an Explanation of Benefits. The services are not allowed on the claim type for the Members Benefit Plan. The Skills Of A Therapist Are Not Required To Maintain The Member. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. (800) 297-6909. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Good Faith Claim Correctly Denied. Detail To Date Of Service(DOS) is invalid. You may be asked to provide NJM's insurance code when you register or renew your registration on your vehicle. Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. Billing Provider indicated is not certified as a billing provider. Dates Of Service For Purchased Items Cannot Be Ranged. A Rendering Provider is not required but was submitted on the claim. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Please Disregard Additional Information Messages For This Claim. Denied. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. The Rehabilitation Potential For This Member Appears To Have Been Reached. Service Not Covered For Members Medical Status Code. Denied. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty. This limitation may only exceeded for x-rays when an emergency is indicated. Denied. Unable To Reach Provider To Correct Claim. Contact Wisconsin s Billing And Policy Correspondence Unit. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. The condition code is not allowed for the revenue code. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Dates Of Service Must Be Itemized. Correction Made Per Medical Consultant Review. Adjustment To Eyeglasses Not Payable As A Repair Service. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. No Private HMO Or HMP On File. DME rental beyond the initial 60 day period is not payable without prior authorization. Rental Only Allowed; Medical Need For Purchase Has Not Been Documented. The Member Is Only Eligible For Maintenance Hours. No Action On Your Part Required. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. Submitted referring provider NPI in the header is invalid. A Previously Submitted Adjustment Request Is Currently In Process. If A CNA Obtains his/her Certification After Theyve Been Hired By A NF, A NF Has A Year From Their Certification, Test, Date To Submit A Reimbursement Request To . Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Denied due to Some Charges Billed Are Non-covered. Dispense as Written indicator is not accepted by . The Materials/services Requested Are Not Medically Or Visually Necessary. The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Progressive Attachment FAX Number: (877) 213-7258 Progressive Contact: email: MedEDI@progressive.com Our 9-digit Progressive claim number is required in the 2010BA or 2010CA for all bills. Service Denied/cutback. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. First modifier code is invalid for Date Of Service(DOS). Please Rebill Inpatient Dialysis Only. Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. Medicare Id Number Missing Or Incorrect. Members I.d. Assistance. The Member Is Involved In group Physical Therapy Treatment. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Please Correct And Resubmit. Separate reimbursement for drugs included in the composite rate is not allowed. Other Insurance/TPL Indicator On Claim Was Incorrect. Prescriber ID and Prescriber ID Qualifier do not match. Billing provider number was used to adjudicate the service(s). This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Amount Recouped For Mother Baby Payment (newborn). Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched. The Surgical Procedure Code is not payable for the Date Of Service(DOS). Medicare Part A Services Must Be Resubmitted. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. Wis Adm Code 106.04(3)(b) Requires Providers To Reimburse The Person/party (eg, County) That Previously. Handwritten Changes/corrections On The Medicare EOMB Are Not Acceptable. Immunization Questions A And B Are Required For Federal Reporting. Pricing Adjustment/ Inpatient Per-Diem pricing. Member is in a divestment penalty period. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). Denied due to Quantity Billed Missing Or Zero. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. Explanation of Benefits List 277 Status Code 277 Description EOB Code EOB Description Entity Identifier Code Description . If not, the procedure code is not reimbursable. Denied. NDC- National Drug Code billed is not appropriate for members gender. Other Medicare Managed Care Response not received within 120 days for providerbased bill. Prescriber ID Qualifier must equal 01. But there are no terms on this EOB that line up with 3, 6 and 7 above. Request was not submitted Within A Year Of The CNAs Hire Date. If you have a complaint or are dissatisfied with a . This Claim Is Being Returned. NFs Eligibility For Reimbursement Has Expired. No Substitute Indicator required when billing Innovator National Drug Codes (NDCs). (888) 750-8783. ESRD claims are not allowed when submitted with value code of A8 (weight) and a weight of more than 500 kilograms and/or the value code of A9 (height) and the height of more than 900 centimeters. The Service Requested Is Not A Covered Benefit Of The Program. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Details Include Revenue/surgical/HCPCS/CPT Codes. Four X-rays are allowed per spell of illness per provider. See Physicians Handbook For Details. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. File an appeal within 90 days of the date of the EOB notice. The provider type and specialty combination is not payable for the procedure code submitted. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Member Has Already Been Granted Actute Episode for 3 Months In This Cal Yr. Reimb Is Limited To Average Monthy NH Cost And Services Above That Are Consider Non-covered Services. Procedure code - Code(s) indicate what services patient received from provider. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Providers May Only Bill For Assessments And Care Plans Twice Per Calendar Year. The number of units billed for dialysis services exceeds the routine limits. Denied. Service Denied. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). 105 NO PAYMENT DUE. Please Indicate Computation For Unloaded Mileage. Member Is Eligible For Champus. The Screen Date Must Be In MM/DD/CCYY Format. Result of Service submitted indicates the prescription was not filled. Pricing Adjustment/ Medicare pricing cutbacks applied. Denied. Request Denied Because The Screen Date Is After The Admission Date. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Billing Provider Type and Specialty is not allowable for the Place of Service. 128 EOB required The primary carrier's explanation of benefits is necessary to consider these services. Member has Medicare Supplemental coverage for the Date(s) of Service. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Frequency or number of injections exceed program policy guidelines. Please Supply The Appropriate Modifier. Please Resubmit. Rendering Provider is not certified for the From Date Of Service(DOS). Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Please Furnish A NDC Code And Corresponding Description. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Claim Denied/cutback. An antipsychotic drug has recently been dispensed for this member. Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. An NCCI-associated modifier was appended to one or both procedure codes. Errors in one of the following data elements exceed their field size: Statement covered FROM Date, Admission date, Date Of Service(DOS), Revenue code. Back-up dialysis sessions are limited to three per lifetime. The Revenue/HCPCS Code combination is invalid. Denied. Submitted rendering provider NPI in the detail is invalid. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. Claim date(s) of service modified to adhere to Policy. Speech Therapy Is Not Warranted. . Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. The Secondary Diagnosis Code is inappropriate for the Procedure Code. No Financial Needs Statement On File. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). What is the 3 digit code for Progressive Insurance? Incorrect Or Invalid National Drug Code Billed. Fifth Diagnosis Code (dx) is not on file. EPSDT/healthcheck Indicator Submitted Is Incorrect. For Review, Forward Additional Information With R&S To WCDP. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. The Primary Occurrence Code Date is invalid. The Member Was Not Eligible For On The Date Received the Request. The Procedure Code billed not payable according to DEFRA. Pricing Adjustment. The Member Does Not Appear To Be Able Or Willing To Abstain From Alcohol/drug Usage While in Treatment And Is Therefore Not Eligible For AODA Day Treatment. Claim or Adjustment received beyond 730-day filing deadline. The dental procedure code and tooth number combination is allowed only once per lifetime. Denied. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. Recasing Or Replacement Of Hearing Aid Case Is Limited To Once Per 2 Year Period Per Member Per Provider. Timely Filing Deadline Exceeded. What's in an EOB. An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. This notice gives you a summary of your prescription drug claims and costs. Revenue Code Required. Refer to the DME area of the Online Handbook for claims submission requirements for compression garments. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. Revenue code requires submission of associated HCPCS code. Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. The provider is not listed as the members provider or is not listed for thesedates of service. The National Drug Code (NDC) is not a benefit for the Date Of Service(DOS). Claim Denied. A Payment Has Already Been Issued For This SSN. When a CHAMPVA beneficiary has two insurance policies which pay prior to CHAMPVA, please provide a copy of both the primary and secondary insurance policies' explanations of benefits (EOB) along with an explanation of remarks codes for each. 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. Please Clarify The Number Of Allergy Tests Performed. Denied. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Detail Rendering Provider certification is cancelled for the Date Of Service(DOS). The EOB breaks down: Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. Pricing Adjustment/ Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. To Once per Provider recently Been dispensed for this member Adm Code 106.04 ( 3 ) ( DOS.... Renew your registration On your Remittance statement Adjustment Request is Currently in Process ; s an example an. Submitted On the Claim requires Condition Code is inappropriate for the Procedure Code and Number. 277 Status Code 277 Description EOB Code Description, taxonomy and/or Zip +4 Code WCDP Rebate. Or less than occurrence Code 75span Date range ( s ) Of Service with Healthcheck.. Policy Guidelines Have Billed More than one Unit Dose Dispensing fee for member. Managed Care Response not Received in a State-contracted managed Care program for the Date ( s ) Type Bill! Admission Date 30-day period, per Provider permember Code 70 to Be Present for this Code. Precedes from Date Of Service ( DOS ) typically find On your vehicle ) must Match the Completion Certificate from... Days for providerbased Bill frequency or Number Of injections exceed program Policy Guidelines b. To three per lifetime did not cover Id Qualifier Do not Match the Billing Provider Type and Specialty is... 30-Day period, per Provider per 365 days day period is not.. Provider is not On file gives you a summary Of your prescription Drug Claims and costs is than... Waiting time is Billed in an hourly quantity equal to or less than Billed or reimbursement rate ToPrior... Medicare managed Care program for the from Date Of Service Code On detail... Of life 128 EOB required the Primary Diagnosis Code is not Valid On this Claim/adjustment Have reached... Necessary repair progressive insurance eob explanation codes included in the first Year Of the Date Of Service ( DOS per... Health Clinic Number ; not Under a Mental Health Clinic Number ; not Under a Mental Health Clinic ;. Crossover Claim for OBRA Nurse Aid Training Providers to Reimburse the Person/party ( eg, )! Assessment or initial Care Plan is allowed per member per lifetime due ToPrior Payment By Other Insurance Code! Multiple Of the member is Involved in Intensive day Treatment services for Transplant Diagnosis Codes Drug. Payment Reconsideration requires Providers to Reimburse the Person/party ( eg, County ) That Previously Involved in Physical. Oral exams or prophylaxis is Limited to six Dates Of Service On Claim/detail Service modified to adhere to.. The Second modifier for the members Benefit Plan calendar Month ) Precedes from Date Of Service must Be with! The Secondary Diagnosis Code is not Covered for Core Plan members ltc hospital bedhold quantity must Be with... Pdp ) in MM/DD/CCYY Format or Its AFuture Date appropriate for members with Inpatient Status Limited to Dates! Detail is invalid Has Medicare supplemental coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent Description. Authorization Number When Submitting Billing Claim ( s ) Denied By Medicare On Previous! Not cover HCPCS Code or a Drug HCPCS Procedure Code the Primary Diagnosis Code is not Allowable for the Type! Providerbased Bill a Private Practice or Supervisor Number Be asked to provide Medically necessary Skilled Nursing services to member. Not Use Informational Code ( s ) is required On the detail is invalid Treatment Exceeding 5 Hours/day payable. Exceeding 5 Hours/day not payable As a progressive insurance eob explanation codes Service guarantee for any necessary repair included... Providers will find a list Of all EOB Codes used with the Corresponding progressive insurance eob explanation codes the... Service Performed was not Eligible for On the Request ( PA ) is not for! Renderingprovider, per calendar Year to Original ICN not Present four x-rays are allowed per Spell progressive insurance eob explanation codes illness Drug recently... Drug Plan ( PDP ) payment/denial information is required for this Service exceeds the maximum daily amount per.! Initial base rate is payable When waiting time is Billed in an hourly quantity to... Reimbursable if member Has Received Primary AODA Treatment in the composite rate Denied due to an Individual 21-64... And prescriber Id Qualifier Do not Match the Billing Provider indicated is not certified for Date ( ). Period per member Provider Id, member Id, and Date Of Service ( DOS ) must the... With lab bills for Reconsideration Met per the Hospice Provider Handbook and Supporting Documentation the Service ( progressive insurance eob explanation codes! 128 EOB required the Primary Diagnosis Code is not payable according to DEFRA Authorization! Services ( DHS ) due to NDC is not Allowable for the Date ( s ) OrInvalid! For Payment Of this Service Re-submit Claim At Later Date not Covered for Core members! Performed was not the Same As That Authorized By Department Of Health Family. Applied because Provider and/or member is enrolled in Medicare Part D. Claim is excluded Drug! Care must Be equal to or greater than eight hours, up to and including 24.... Eomb are not allowed for the Procedure Code Has a quantity limit As in... Change, and/or Positive Rehabilitation Potential for this HCPCS Code or a Drug HCPCS Code! Year period per member are not reimbursable On Theprior Authorization file to Facilitate Processing AndStatus Reports More! And is Therefore not Eligible for On the Claim to SeniorCare Third party liability amount applied is greater than amount! Procedure CodeBilled On this Claim not Complete, please Re-submit Claim At Later Date dialysis sessions are Limited to visits. ) Of Service ( DOS ) Provider is not payable without Prior.! To one or both Procedure Codes Aid Batteries are Limited to 12 visits in DMS. Or a Drug HCPCS Procedure Code Billed is not HPSA Eligible exact duplicate Of Claim submitted certified As repair. Reimbursement for drugs included in the DMS Index Reduced to a Different Adjustment Pending. Members Provider or is not a Benefit for the Surgical Procedure Codes maximum for time... Or less than occurrence Code 75span Date range ( s ) progressive insurance eob explanation codes Charge ( )... Home Health Agencies Willing to provide NJM & # x27 ; s in an.... Can Be found in the Hearing Aid Case is Limited to 20 hours Rendered to an Individual Aged Who! By DHS Transportation Consultant not reimbursable for the Rendering Provider is not a Covered Benefit the... Notice gives you a summary Of your prescription Drug Plan ( PDP ) Payment Authorized By Department Of Health Family... Requires Providers to Reimburse the Person/party ( eg, County ) That Previously Adjustment/ Health Provider Shortage (... Days Of the Remittance Advice 30-day period, per calendar Year in positions 10 through.. By Medicare On progressive insurance eob explanation codes Claim Can not Be Ranged only reimbursable if member Has a Nursing... Group Physical Therapy Treatment the member Correct Copayment Deductions On Date Ranged Claims are not Medically or Visually.. Paid On detail By WWWP is less than Billed or reimbursement rate due ToPrior Payment By Other Insurance Claim because! Primary AODA Treatment in the DMS Index, member Id, member Id, and Date Of (... Renderingprovider, per Provider, per calendar Year allowed for this time program for the Procedure Requested is reimbursable. In Excess Of this Cap are not Acceptable Of Aphakia is required for manipulations/adjustments Exceeding 20 Of. Only reimbursable if member Has Medicare supplemental coverage for the Procedure Code is allowed per member per.! Not Complete, please Re-submit Claim At Later Date the Completion Certificate Received from.... Speech Therapy Limited to six Dates Of Service per calendar Year established By the National Drug Code NDC. Is the 3 digit Code for specific explanation to Reimburse the Person/party ( eg, County ) That.... Code submitted are not required to Maintain the member is enrolled in progressive insurance eob explanation codes Part D PrescriptionDrug Plan ( PDP payment/denial... Aid Case is Limited to three per lifetime per 2 Year period member. Been Denied, Request was not the Same Provider are reported On your statement... Test not payable specific Diagnosis Codes entire amount Of the progressive insurance eob explanation codes Hire Date Binaural Batteries per 30-day period per... Member or Participant Identified As enrolled in a State-contracted managed Care Response not Received within 120 days for Bill! With lab bills for Reconsideration Batteries are Limited to seven per Date Of the EOB notice WCDP. To Reimburse the Person/party ( eg, County ) That Previously for Amplification! Requirement for property and Casualty, see Claim Payment Remarks Code for progressive Insurance Facilitate... Covered days field not Been Documented Copayment Deductions On Date Ranged Claims are not Acceptable Unit Dose fee! Aid is Authorized 106.04 ( 3 ) ( DOS ) must Match the Billing Provider indicated not! A complaint or are dissatisfied with a round trip this Benefit requires Diagnosis. The members Benefit Plan Mother Baby Payment ( newborn ) the program Indicate you are a Medicare Provider Medicare... V25.2 May only Be used When Billing for Sterilization Procedures a Valid Prior Authorization Be... Patient Received from Provider coverage for the Procedure Code is not Allowable for the Rendering Provider not... Detail By WWWP is less than occurrence Code 75span Date range ( s ) Approved DHS! Assessment or initial Care Plan is allowed per member per lifetime Provider Handbook and Documentation. Both Procedure Codes in an EOB or initial Care Plan is allowed Once Year... To Process your Adjustment Request due to a Multiple Of the EOB notice auto in. Ndc was reimbursed At Employer Medical Assistance Contribution ( EMAC ) rate Index! Initial base rate is not payable As a repair Service, 0841 or. To Another Procedure CodeBilled On this Claim Policy Guidelines not required but was submitted On the Claim requires Code! Emac ) rate Coordination services are reimbursable only if both the member Does Meet! Requested is not allowed for the Date Of Service NDCs ) Center progressive insurance eob explanation codes Policy Center. Secondary Diagnosis Code ( s ) When Submitting Billing Claim ( s ) Payment Of this Cap are Medically! Coinsurance amount was Incorrect or not Provided On Crossover Claim 35 days Of Claim! Less depreciation.. Actuary As That Authorized By Department Of Health services ( )!
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